Three bills could bring broader medical practice

She said the main reason that nurse practitioners are seeking independent practice is efficiency. For example, if a nurse orders a test for a patient, the results are delivered to the supervising doctor, even if he or she has never once seen the patient, she said.

Part of the process of moving from registered nurse to nurse practitioner is learning to understand when it is time to seek consultation from a medical doctor, she said.

“If there is a complex patient situation, we would obviously be referring to a physician. That’s our professional responsibility,” she said.

She argued that not requiring nurse practitioners to co-locate with doctors would also allow them to move to underserved parts of the state, such as rural or poor urban communities.

Optometrists

Today, optometrists can perform eye exams, prescribe prescriptions lenses, treat eye infections like conjunctivitis and diagnose and treat many other types of eye-related disease, like glaucoma, with special additional certifications from the state board of optometry. They are required to consult with an ophthalmologist in certain cases that would be reduced under the bill, SB492.

The bill would redefine the practice of optometry, and would allow practitioners to diagnose and treat “any disease, condition or disorder of the visual system, the human eye, and adjacent and related structures, even administering narcotic drugs and immunizations with the proper certification from the optometry board.”

The changes are not limited to the visual system. A separate section of the bill allows an optometrist to diagnose “other conditions that have ocular manifestations, initiate treatment, and, in consultation with a physician, manage medications for these conditions.

That sentence raises the hackles of the medical association.

Phinney, the CMA president, said the paragraph is so vague that it could be interpreted to mean that optometrists could treat cancer or HIV and a host of other serious conditions that can show up in the eye.

“The bill language is crazy, because it basically allows optometrists to treat any condition that manifests in the eye,” Phinney said. “That is so wide open that it’s dangerous and reckless.”

Hernandez, a licensed optometrist, said the language is not intended to allow treatment of cancer or any other specialized disease. Rather, the said that it is intended to allow broader latitude with chronic diseases like diabetes, which is often first detected by an optometrist in the course of a regular eye exam. He said optometrists already take basic medical histories of their patients, which include blood pressure, height, weight and sometimes even blood glucose.

“In collaboration with a physician, we should be able to start those medications, and get them into a primary care medical home,” Hernandez said.

Pharmacists

A third bill, SB493, would allow pharmacists to administer hormonal contraceptives and prescription smoking-cessation drugs, and independently initiate and administer routine vaccinations. The bill would also create a new certification “advanced practice pharmacist,” which would allow a practitioner who is collaborating with one or more doctors to “adjust or discontinue a drug therapy” as long as they promptly notify the patient’s doctor.